MEMBERSHIP

MEMBERSHIP APPLICATION

(FOR CHECK PAYMENTS ONLY)

SECTION 1: Applicant Information

Please fill out all fields, accept terms and hit send button.

* Required

Last Name:*	SUFFIX/DEGREE:
First Name:*	Middle Initial:
Motorsports Affiliation:
Address:*
City:*	State/Province:*
Postal Code:	Country:*
Telephone: (ICMS Member Directory) *
Telephone: (ICMS use only)	CellHomeOffice
Email Address:*

SECTION 2: Membership Categories

Please select the appropriate membership category and then using the drop down menu select your occupation. If your occupation is not listed, complete the “Other” section.

Medicine

Annual Dues $400.00

Science & Education

Annual Dues $300.00

Associate Member*

Annual Dues $150.00

Occupation

Student

Annual Dues $50.00

*Includes all the rights and privileges of membership, except those of voting or holding office.

SECTION 3: Payment Instructions

(CHECK PAYMENTS ONLY)

You can pay with a Personal Check or Corporate Check. Make sure your full name is on the memo section. If the check payment is for more than one applicant, please complete and submit an online application for each person. Once the online application(s) is submitted you will receive an email confirmation. Please print the email(s) and mail it with your check to: The ICMS, 5139 Greenheart Drive, Indianapolis, IN 46237.

SECTION 4: Submitting Membership Application

To submit your membership application check the box below and hit the “send” button.

If you have any questions regarding membership or this application, please contact Tom Weisenbach, the ICMS Executive Director by email at tom@theicms.org.

Submitting your application confirms and acknowledges that you have reviewed and verified the accuracy of your application.

NOTE: Once we receive your application and payment, you will receive an email with instructions on how to create a user name and password to access the Members Only section of our website.